Tuesday, 13 March 2012
Rural and Regional Health Services
I rise tonight to speak about mental health in our regional, rural and remote areas. Access to quality health care, including mental health care, is a basic human right. With one in five Australians experiencing mental health issues in any given year, mental health policy goes to the heart of our nation's wellbeing and touches all of us wherever we live in this wide, sometimes drought-stricken, sometimes flooded, always challenging land. It is therefore vital that adequate funding and attention are given to all aspects of mental health everywhere in Australia.
Generally, it is estimated that the prevalence of mental health conditions in rural and remote Australia is equivalent to that of our major cities. But the consequences of mental illness may often be far greater for many people living in country areas. There are two reasons for this. Firstly, there is the increased difficulty of getting the support and treatment needed for mental illness in places away from urban areas. Secondly, there is the greater visibility and stigma that may be attached to mental ill health in our smaller communities.
The shortage of mental health professionals in regional, rural and remote Australia is a key problem. We know that many people with a mental illness, regardless of their location, struggle to find adequate care. But this problem is amplified in many of our regional, rural and remote areas where there are likely to be fewer health professionals, a much smaller choice of health service providers and few community support services.
Many general practices in rural and remote Australia have long waiting lists. Country GPs face unique challenges, often being the only medico or medicos over a vast geographic area and with many patients. Indeed, at a recent breakfast with the Rural Doctors Association of Australia, these challenges were brought home to me quite graphically. They find it difficult to find the time to do additional training. And having time off—like holidays—for their own mental health is rare. Referral options are often limited. In the mental health arena, specialist assistance can be very hard to access. The vast majority of psychiatrists—about 90 per cent of them—not surprisingly are based in cities. And the valuable community programs which are run by non-government organisations in urban areas are likewise hard to access in many regional and country locales. In addition, the provision of after-hours services, which are often crucial in the mental health arena, is also very challenging for country GPs because of a lack of colleagues to share the load, inadequate financial support and the lack of after-hours and emergency services on a full-time basis across many rural hospitals.
Consistently over time statistics are witness to the fact that people in rural and remote areas have lower levels of access to specialised mental health services. In 2008, the Mental Health Council of Australia reported on the distribution of new MBS item numbers for mental health services. The rate of usage in regional areas varied between 40 and 90 per cent of that in major cities, but in remote areas it was even worse: between 10 and 30 per cent. The recent Senate inquiry into Commonwealth funding and administration of mental health services reported that the evaluation of the Better Access program confirmed that the usage and distribution of services under Better Access dropped off dramatically in rural and remote Australia. For example, the use of services was approximately 12 per cent lower for people in rural areas and approximately 60 per cent lower for people in remote areas, compared to that for people living in capital cities. There was some discussion as to the reason for this, and the Royal Australian College of General Practitioners suggested it was due to workforce shortages in those rural and remote areas.
Although the prevalence of mental health conditions appears to be similar across rural and remote and urban areas, there are some particular areas of concern. Not surprisingly, treatment of severe and persistent mental illnesses such as schizophrenia and bipolar affective disorder is very challenging because of a lack of specialist services, community mental health teams and intensive support community programs to promote and maintain recovery. And suicide is a particular and very troubling issue, especially in relation to men and boys. At any given time, rates of suicide tend to increase with increasing distance from urban areas. The Australian Health and Welfare 2007 mortality report shows that males between 15 and 24 living in regional areas are 1.5 to 1.8 times more likely to end their life by suicide than their urban counterparts. In very remote areas, the incidence can be up to six times higher.
The National Rural Health Alliance has a series of fact sheets, including one which refers to the incidence of male youth suicide. Again, it cites the statistic that this occurs at almost twice the rate of that in metropolitan areas. Factors in rural areas include loneliness, the loss of relationships brought about by the drift of many younger rural people to coastal and urban areas, alienation due to lack of understanding in some rural communities for same-sex preferences—and this brings to mind those shameful ads that have been broadcast in Queensland recently exacerbating that problem—unrecognised or untreated depression exacerbated by the lack of services and treatment options, and alcohol and other drug misuse. Again, according to the Australian Health and Welfare mortality report, there is a similar poor comparison for men in the 25- to 44-year age bracket, where national suicide rates for men are highest.
Some research suggests that farmers have twice the suicide rate of any other occupational group in Australia. Research from the CSIRO has found that farmers in vulnerable communities are currently already suffering from serious mental health issues, and there are predictions that this will be exacerbated by increasingly volatile weather conditions and natural disasters heralded by climate change. There are many factors which play a role in pushing people living in rural communities to breaking point. These include vulnerability to extreme weather events such as floods and droughts, changing market conditions, lack of mental health facilities and support services and prolonged social isolation.
The Centre for Rural and Remote Mental Health is currently conducting research into influences on farmer suicide in Queensland and New South Wales under the leadership of Griffith University in Queensland. Through interviews with farmers and community groups, it aims to gain a better understanding of the factors that place farmers at risk and highlight strengths in the community to assist farmers in distress. Research of this kind is valuable and necessary if we are to have effective policy which will help not only to prevent individual suicides, each of which is devastating for the individual, families and communities involved but also to seek to reverse a tragic trend.
The federal and state governments have varied programs and initiatives to provide access to mental health services in rural and remote areas. They fund divisions of general practice, Aboriginal medical services and the Royal Flying Doctor Service to engage mental health nurses and allied health professionals including psychologists, social workers, occupational therapists and Aboriginal health and mental health workers. The federal government's rollout of the youth focused headspace centres and the introduction of e-mental health services online are important steps towards meeting the needs of Australians who are living outside urban centres.
These varied programs are very important, but the evidence is that they need to be expanded, together with other local support services which ensure that people can participate fully in community life to promote resilience, enhance recovery from mental illness and prevent relapse. Support for carers, who are vital for the maintenance of their loved ones' mental health, secure housing, employment and educational opportunities, transport and services that offer relationships and community engagement are all as vital for country people as they are for their city cousins.
Having learned much from listening to those with lived experience of mental ill-health in my past work, I believe that the voices of rural Australia must be heard in any mental health policy that seeks to address their needs. It is for this reason that I will be visiting regional, rural and remote Australian communities in the coming months to meet with and listen to the real experts on this topic. I will be seeking to build upon the Greens' current mental health policies so that we can establish the best ways to achieve a robust, responsive, accountable and ultimately effective mental health service for rural Australians. They—we—deserve nothing less.